critical thniking

• Critical thinking


  The process of intentional higher-level thinking to define a client's problem, examine the evidence-based practice in caring for the client, and make choices in the delivery of care
• Critical thinking


  • The ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process
  • Recognizing that an issue exists, analyzing information, evaluating information, and drawing conclusions
• Critical thinking is an essential skill needed for the identification of client problems and the implementation of interventions to promote effective care outcomes
• The process of providing feedback and reflection is vital to the improvement of nursing practice
• A study by Asselin (2011) revealed that students who reflected on new knowledge developed new insights regarding practice
• Clinical reasoning


  The cognitive process that uses thinking strategies to gather and analyze client information, evaluate the relevance of the information, and decide on possible nursing actions to improve the client's physiological and psychosocial outcomes
• Clinical reasoning


  • Requires the integration of critical thinking in the identification of the most appropriate interventions that will improve the client's condition
  • Evolved from the application of decision-making to the health care professions
• Components of clinical reasoning

  • Clinical reasoning is the analysis of a clinical situation as it unfolds or develops
  • Cognitive processes are the thinking processes based on the knowledge of aspects of client care
  • Metacognitive processes include reflective thinking and awareness of the skills learned by the nurse in caring for the client
• Nurses use critical thinking and clinical reasoning skills when making decisions about client care
• The decision-making process includes prioritizing care not only with one client but when providing care to many clients
• Nurses must make decisions and also assist clients to make decisions
• When faced with several client needs at the same time, the nurse must prioritize and decide which client to assist first
• Logical reasoning


  A critical thinking skill that closely aligns with clinical reasoning
• In the planning of care, nurses must question whether knowledge they possess about the care of the client is consistent with the most current evidence-based practice
• The nurse must review the most current nursing and health-related literature prior to implementing care
• A nurse's ability to accurately implement and integrate critical thinking, clinical judgment, and clinical reasoning is enhanced with a commitment to lifelong learning
• Clinical judgment


  An essential skill that involves the interpretation of a patient's needs, concerns, or health problems
• Clinical decision


  • Making accurate & appropriate decisions
  • Nurses must learn to question, wonder, and explore different perspectives and interpretations to find a solution that benefits the patient
  • Separates nurses from technical personnel
• Decision-making


  Application of components of critical thinking: knowledge, attitude, clinical experiences, professional standards
• Critical analysis


  The application of a set of questions to a particular situation or idea to determine essential information and ideas and discard unimportant information and ideas
• Socratic questioning


  A technique one can use to look beneath the surface, recognize and examine assumptions, search for inconsistencies, examine multiple points of view, and differentiate what one knows from what one merely believes
• Inductive reasoning


  Generalizations are formed from a set of facts or observations
• Deductive reasoning


  Reasoning from general premise to the specific conclusion
• Levels of critical thinking

  • Basic critical thinking
  • Complex critical thinking
  • Commitment critical thinking
• General critical thinking competencies

  • Scientific method
  • Problem solving
  • Decision making
• Specific critical thinking competencies

  • Diagnostic reasoning and inference
  • Clinical decision making
• The nursing process is used as a competency when delivering patient care
• Nursing process

  A five-step clinical decision-making approach with the purpose of diagnosing and treating human responses to actual or potential problems

  
• The nursing process requires the nurse to use general and specific critical thinking competencies

  
• Nursing process system


  • A systematic, rational method of planning and providing individualized nursing care
  • Its purposes are to identify a client's health status and actual or potential health care problems or needs, to establish plans to meet the identified needs, and to deliver specific nursing interventions to meet those needs

  
• The use of the nursing process in clinical practice gained additional legitimacy in 1973 when the phases were included in the American Nurses Association (ANA) Standards of Nursing Practice
• Purpose of the nursing process

  • To identify a client's health status and actual or potential health care problems or needs
  • To establish plans to meet the identified needs
  • To deliver specific nursing interventions to meet those needs
• Characteristics of the nursing process

  • Cyclical and dynamic nature
  • Client centeredness
  • Focus on problem solving and decision making
  • Interpersonal and collaborative
  • Universal applicability
  • Use of critical thinking and clinical reasoning

  
• Phases of the nursing process

  • Assessment
  • Diagnosing
  • Planning
  • Implementation
  • Evaluation

  
• Assessment


  Deliberate & systematic collection of information about a patient to determine his/her current & past health and functional status & his/her present and past coping patterns
• Types of assessment


  • Patient-centered interview during a nursing health history
  • Physical examination
  • Periodic assessments made during rounding or administering care
• Types of assessment (Kozier-Erb's 11th Ed.)

  • Initial assessment
  • Problem-focused assessment
  • Emergency assessment
  • Time-lapsed reassessment
• Data collection


  • Collection and verification of data
  • Analysis of data
• Database


  Contains all the information about a client; it includes the nursing health history, physical assessment, primary care provider's history and physical examination, results of laboratory and diagnostic tests, and materially contributed by other health personnel
• Sources of data


  • Primary (patient, interview, observation, physical examination)
  • Secondary (family, health care team, medical records, scientific literature, nurse's experience)